Hospitals across Canada are voluntarily adopting a surgery checklist in a move aimed at avoiding the kind of errors that led to two unnecessary mastectomies in Windsor, Ont.

Hôtel-Dieu Grace Hospital in Windsor announced Wednesday its review has uncovered seven serious "cases of concern" following a review of incorrect pathology reports, including two women who each had a breast removed when they did not actually have cancer.

Starting April 1, the Ontario government will require that hospitals use and comply with a surgical checklist. Some hospitals across Canada have also elected to adopt a similar checklist.

Similar to an airline pilot's pre-flight checklist, the single-page of procedures requires the surgical team to take a few moments to check common tasks and items, such as patient information and equipment.

A study published in the New England Journal of Medicine in January 2009 found that complications — anything from an infection of the surgical site to a heart attack or death — occurred in 11 per cent of patients before the World Health Organization's checklist was adopted and seven per cent afterwards.

The rate of death declined from 1.5 per cent before the checklist was introduced to 0.8 per cent afterwards.

One of the first items on the list is to confirm lab tests, biopsies and X-rays.

"With the checklist, the concept is to actually look at and report on the pathology and biopsy report right in the operating room from the chart or the computer," said Dr. Michael Baker of Toronto's University Health Network, who is responsible for ensuring the surgical checklist is implemented at hospitals across the province.

To follow the checklist, doctors and nurses on the surgical team are required to:

  • Ensure that the necessary anesthesia, blood and intensive care beds are in place, and that any allergies are identified.
  • Verbally confirm that the surgical site and pathology are correct.

Studies have shown that communication problems are the source of most medical errors — a gap that the checklist helps to fill by offering a structured and documented approach to the surgical team's conversations.

"What's happening is that the team, the nurse, anesthesia, surgeons are openly talking about key safety issues at three specific time points during the surgery," said Dr. Chris Hayes, medical officer of the Canadian Patient Safety Institute in Toronto.

The three points are before the anesthesia is given, before the incision, and before the patient leaves the operating room. There is evidence that improving teamwork improves outcomes in the operating room, Baker agreed.